Prior Disability Prevention Training Promoted Resilience of Racially and Ethnically Minoritized Older Adults During COVID-19
Key findings
- The six-month Positive Minds–Strong Bodies (PMSB) intervention, delivered in 2015–2019 by paraprofessionals to at-risk older adults, reduced depression and anxiety symptoms and improved physical function. Those effects remained significant for 12 months
- This follow-up study, conducted from March 2, 2021, to July 18, 2022, investigated how the PMSB intervention affected participants' health outcomes during the COVID-19 pandemic
- Relative to older adults who received extended usual care, those who received the PMSB intervention had fewer symptoms of depression and higher levels of physical functioning during and after the COVID-19 pandemic
- These results add to growing evidence that the PMSB intervention can promote enduring resilience and prevent disability associated with significant life stressors
In 2019, researchers at Massachusetts General Hospital published a randomized, controlled trial of Positive Minds–Strong Bodies (PMSB), a low-cost disability prevention intervention for older adults. Six months of psychosocial and exercise training improved mood symptoms and physical function, and the effects remained significant for six months after the intervention.
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Now, Margarita Alegría, PhD, chief of the Disparities Research Unit at Mass General and professor of Medicine and Psychiatry at Harvard Medical School, Mayra L. Sánchez González, PhD, of Johns Hopkins University School of Medicine, and colleagues have reported intriguing longer-term results in American Psychologist.
Two to six years after the original study—during the COVID-19 pandemic—individuals who had participated in the PMSB intervention reported fewer symptoms of depression and better physical functioning than those who had received enhanced usual care.
The Original Study
Recruitment for the original study occurred at clinics and community-based organizations serving low-income racially and ethnically minoritized or immigrant older adults (age ≥60) in Massachusetts, New York, Florida, and Puerto Rico. Individuals were eligible if they self-reported mild to severe depression or anxiety symptoms and were objectively evaluated as having minor to moderate physical disability.
The trial enrollment period was from May 25, 2015, to March 5, 2019. Participants were randomly assigned to:
- PMSB intervention (n=153)—10 one-hour individual sessions adapted from cognitive-behavioral therapy and delivered by a trained community health worker over six months, concurrent with three weekly group sessions of functional exercises delivered by an exercise trainer over 12 to 14 weeks.
- Enhanced usual care (EUC, n=154)—A booklet on mental and physical self-care plus calls from research assistants every two weeks for six months to monitor symptoms of depression, anxiety, and suicide risk and provide empathetic support.
Methods for the Follow-up Study
The COVID-19 follow-up assessment was completed between March 2, 2021, and July 18, 2022, about 2.4 to 5.9 years after treatment completion. 27 of the 307 individuals in the original study had died, and 17 were cognitively impaired or too ill to participate. 165 of the remaining 263 participants completed the same outcome measures as in the original study:
- Hopkins Symptom Checklist–25 (HSCL-25, anxiety and depression symptoms in the past 30 days)
- Generalized Anxiety Disorder–7 (GAD-7)
- Geriatric Depression Scale–15 (GDS-15)
- Function component of the Late-Life Functioning and Disability Instrument (Late-Life FDI)
- World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)
Participants were also interviewed about how COVID-19 affected them (e.g., infection, hospitalization, and job loss).
Results
Participants in the PMSB and EUC groups were equally likely to be diagnosed with COVID-19, be hospitalized due to COVID-19, or have a close friend or family member diagnosed with COVID-19.
Comparisons of the average scores in the PMSB and EUC groups revealed:
- Psychological distress (HSCL-25)—No significant difference
- Anxiety symptoms (GAD-7)—No significant difference
- Depression symptoms (GDS-15)—1.07 points lower with PMSB than EUC (P=0.021)
- Level of functioning (Late-Life FDI)—6.51 points lower with PMSB than EUC (P=0.038)
- Level of disability (WHODAS 2.0)—No significant difference
The significant differences between the PMSB and EUC groups in GDS-15 and Late-Life FDI scores were mediated by the initial six- and 12-month intervention effects.
These results provide evidence that the PMSB intervention can promote enduring resilience, strengthening the capacity of vulnerable older adults to adapt successfully to major life stressors.
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